State of the Evidence for Standard-of-Care Treatments for Croup: Are We Where We Need to Be?

Abstract

Three conclusions were reached: (1) no steroid treatment studies of moderate or severe laryngotracheitis have been of adequate size to determine the risk of progressive viral infection or secondary bacterial infection; (2) single dose steroid treatment or limited nebulized use is probably safe; and (3) we should encourage better clinical diagnosis of croup illnesses.

Subglottic laryngitis – Changes in therapy approach over the past 20 years

“…Bacterial croup is usually secondary infection with Staphylococcus aureus, or other common bacterial pathogens like Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis [23]. It usually involves spreading of the infection and regarding pathology there is extensive exudate and pseudomembrane formation at the bronchial and bronchiolar levels, which results with progressive airway obstruction [23]. Over the decades there was a trend of antibiotic use, which was believed to prevent this obstruction.…”

“…One of the studies on recurrent croup and allergy showed that children with specific parainfluenza IgE antibodies who had croup more frequently released histamine into the airway than children with upper respiratory tract infection caused by the same pathogen [23,24]. The possible correlation between allergy and croup was investigated over the years, and this may have resulted in the usage of antihistaminics in treatment of croup [25][26][27][28].…”

“…The pathology of laryngotracheitis represents combined influence of cytopathological effect of parainfluenza virus and host response to viral infection [3,23]. One of the studies on recurrent croup and allergy showed that children with specific parainfluenza IgE antibodies who had croup more frequently released histamine into the airway than children with upper respiratory tract infection caused by the same pathogen [23,24].…”

“…In history, there was a belief that bacteria (especially Corynebacterium diptheriae) had the main role in etiology of croup [3]. Over the years etiology of croup has been clarified, and it is known that bacteria represent a very small piece of the puzzle of etiology [3,22,23]. Bacterial croup is usually secondary infection with Staphylococcus aureus, or other common bacterial pathogens like Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis [23].…”

“…Over the years etiology of croup has been clarified, and it is known that bacteria represent a very small piece of the puzzle of etiology [3,22,23]. Bacterial croup is usually secondary infection with Staphylococcus aureus, or other common bacterial pathogens like Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis [23]. It usually involves spreading of the infection and regarding pathology there is extensive exudate and pseudomembrane formation at the bronchial and bronchiolar levels, which results with progressive airway obstruction [23].…”